FUNDA LEC

• Sleep


  A basic human need, a universal biological process common to all individuals, an alteration in a person's state of consciousness in which their ability to recognize and respond to stimuli is reduced
• Sleep


  • Enhances daytime functioning and is vital for cognitive, physiologic, and psychosocial function
  • Exerts physiologic effects on both the nervous system and other body structures
  • Restores normal levels of activity and normal balance among parts of the nervous system
  • Needed for protein synthesis to facilitate repair process
• Wakefulness and sleep


  • Wakefulness is maintained and mediated by some stages of sleep
  • Sleep is an active process involving the RAS and a dynamic interaction of neurotransmitters
• Serotonin


  A major neurotransmitter associated with sleep, derived from its precursor Tryptophan, decreases activity of RAS, thereby inducing and sustaining sleep
• Serotonin, GABA, Acetylcholine, Dopamine, Noradrenaline


  Neurotransmitters involved in sleep-wake regulation
• Melatonin


  When secreted by the pineal gland, it reduces alertness
• Growth hormone


  Increased during sleep
• Cortisol


  Inhibited during sleep and highest during the beginning of daylight
• Biorhythms


  Rhythmic biologic clocks that exist in plants, animals, and humans, controlled from within the body and synchronized with environmental factors such as light and darkness, gravity and electromagnetic stimuli
• Circadian rhythm


  The most familiar biorhythm, from the Latin words "circa dies" meaning about a day
• Sleep stages


  1. NREM stage 1 sleep

  2. Light sleep

  3. Deep sleep

  4. REM sleep
• Very light sleep


  • Drowsiness, relaxation, rolling of eyes from side to side, pulse rate and respiratory rate drops slightly, person can be easily awakened
• Light sleep


  • Continuous slowing down of body processes, eyes are steady, pulse rate and respiratory rate are slightly reduced, reduced temperature, needs more intense stimuli such as touching or shaking to awaken a person
• Deep sleep


  • Deepest stage of sleep and important for restoring energy and secretion of growth hormones, pulse and respiratory rates drop 20% to 30%, relaxed muscles, reduced reflexes, snoring, person is hard to awaken and does not react to sensory stimuli
• REM sleep


  • High brain activity and metabolism, distinctive eye movements, extremely reduced voluntary muscle tone, absent deep tendon reflexes, increased gastric secretion, irregular pulse and respiratory rates, dreaming, person is difficult to awaken or may wake spontaneously
• Characteristics of NREM and REM sleep


  • NREM: Regular respiration, closed eyes, absence of body and eye movements
  • REM: Rapid eye movements observable through closed lids, body movements and irregular respiration
• 50% of sleep is REM
• Sleep patterns in infants


  • Awake for 1-3 hours and requires 12-18 hours of sleep
  • Awake for 3-4 hours to feed, episodes of wakefulness slowly increases during the first months, sleeps the entire night (12am – 5am) and starts to establish a pattern of daytime naps (2 times a day), 9-12 hours of sleep in 24 hours by the end of first year
• Sleep patterns in toddlers


  • Some sleep as long as 22 hours a day, others 12-14 hours a day, about 20 – 30% of sleep is REM, about half of sleep time is spent in light sleep, exhibits a great deal of activity such as movement, gurgle and coughing
• Sleep patterns in preschoolers


  • Requires 12-14 hours of sleep, requires afternoon naps but need for midmorning naps slowly reduces, resists going to bed and may awaken at night, about 20-30% of sleep is REM
• Sleep patterns in school-age children


  • Requires 11-13 hours of sleep, sleep requirements changes relative to activity and growth spurts, about 20-30% of sleep is REM, higher than adults however stage 1 sleep is less
• Sleep patterns in pre-adolescents


  • Requires 10-11 hours of sleep, reduce hours of sleep due to many demands from school and other social activities, reduce hours of sleep may also be related to use of computer/TV as well as intake of caffeinated beverage, REM sleep is reduced to 20% and gradually decreases as the child grows
• Sleep patterns in adolescents


  • Requires 9-10 hours of sleep, desire for more independence becomes a factor for later bedtime, drowsy at times and places where they should be alert, boys start to have episodes of nocturnal emission of "wet dreams", sleep is about 20% REM
• Sleep patterns in adults


  • Requires 7-9 hours of sleep, students, shift workers, travelers, and those who are sick are vulnerable for sleep deprivation, biologic conditions (pregnancy, menses, perimenopausal period) can influence a woman's pattern of sleep, flattened circadian rhythm; earlier bedtime and morning arousal (advanced sleep phase syndrome), awakens an average of 6 times at night with difficulty of falling back to sleep, day time napping and illness decreases nocturnal sleep
• Factors that can disrupt sleep


  • Pain or physical distress
  • Respiratory conditions
  • Gastric or duodenal ulcers (pain)
  • Endocrine disturbances (hyperthyroidism or hypothyroidism)
  • Noise, unfamiliar surroundings
  • Discomfort from environmental temperature, lack of ventilation
  • Light levels
  • Low levels of estrogen in women
  • Increase body temperature
  • Nocturia (excessive urination at night)
  • Irregular morning and nighttime schedule
  • Ability to relax before retiring
• Factors that can disrupt sleep (continued)

  • Anxiety and depression increase norepinephrine blood level through stimulation of SNS
  • Stress increase activation of the hypothalamic pituitary adrenal (HPA) axis
  • Caffeine containing beverages stimulates CNS
  • Alcohol disrupts REM sleep
  • Nicotine has a stimulating effect on the body, smokers have difficulty falling asleep, they become light sleepers
• Factors that can affect sleep

  • Weight loss is associated with increased sleep time
  • Weight gain is associated with reduced sleep time
  • Dietary l-tryptophan in cheese and milk include sleep
  • Can increase alertness in some situations, an individual probably stay alert while attending a concert, when a person is bored, sleep often readily ensues
• Medications that can affect sleep

  • Hypnotics interfere with deep sleep and suppress REM
  • Beta blockers can cause insomnia and nightmares
  • Narcotics (morphine, codeine) can cause drowsiness
• Factors that can interfere with sleep

  • Noise, unfamiliar surroundings
  • Discomfort from environmental temperature, lack of ventilation
  • Light levels
  • Anxiety and depression increase norepinephrine blood level through stimulation of SNS
  • Stress increase activation of the hypothalamic pituitary adrenal (HPA) axis
  • Caffeine containing beverages stimulates CNS
  • Alcohol disrupts REM sleep
  • Nicotine has a stimulating effect on the body
  • Smokers have difficulty falling asleep, they become light sleepers
• Weight loss

  Increased sleep time
• Weight gain

  Reduced sleep time
• Dietary l-tryptophan in cheese and milk

  Include sleep
• Alertness

  Can increase in some situations
• Boredom

  Sleep often readily ensues
• Hypnotics

  • Interfere with deep sleep and suppress REM
• Beta blockers

  • Can cause insomnia and nightmares
• Narcotics (morphine)

  • Cause frequent awakenings & drowsiness
• Substances associated with sleep problems

  • Alcohol
  • Amphetamines
  • Antidepressants
  • Beta-blockers
  • Bronchodilators
  • Caffeine
  • Decongestants
  • Narcotics
  • Steroids
• Substances that can cause sleep problems

  • Antidepressants
  • Antihistamines
  • Beta blockers
  • Narcotics
• Sleep disorders

  Typically categorized for the purpose of research as dyssomnias, parasomnias, and disorders associated with medical or psychiatric illness